Basic Information
| Provider Information | |||||||||
| NPI: | 1609949775 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HILO MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089746700 | ||||||||
| FaxNumber: | 8089746723 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089746700 | ||||||||
| FaxNumber: | 8089746723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHURRA | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8089744729 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | OHCA# 44-N | HI | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | E005032 | 01 | HI | HMSAQUEST SNF | OTHER | T005037 | 01 | HI | HMSAQUEST ICF WL | OTHER | U005035 | 01 | HI | HMSAQUEST ICF ANC | OTHER | D005035 | 01 | HI | HMSAQUEST ICF | OTHER | N005032 | 01 | HI | HMSAQUEST ANC | OTHER | 251745 | 01 | HI | ALOHACARE | OTHER | A005031 | 01 | HI | HMSAQUEST SNF WL | OTHER | 251745 | 05 | HI | MEDICAID | E005032 | 01 | HI | HMSA SNF | OTHER | P005038 | 01 | HI | HMSAQUEST ICF WL | OTHER |